腹腔镜手术联合药物治疗子宫内膜异位症的疗效观察

【目的】探讨腹腔镜手术联合药物治疗子宫内膜异位症的临床疗效。【方法】回顾性分析2008年4月至2011年8月在本院因慢性盆腔痛行腹腔镜手术并经病理诊断为子宫内膜异位症的128例患者，比较单纯性腹腔镜手术（对照组）和腹腔镜手术联合内美通（内美通组）或诺雷德（诺雷德组）治疗子宫内膜异位症相关性慢性盆腔痛患者的疗效、妊娠率、术后复发率及药物不良反应的发生率。【结果】所有患者行腹腔镜手术治疗后，慢性盆腔痛、痛经、月经紊乱、不孕、卵巢囊肿等症状均有不同程度的缓解。内美通组和诺雷德组的症状缓解率、妊娠率均较对照组明显提高，复发率明显降低（P〈0．05）；内美通组和诺雷德组两组之间在疼痛缓解、术后复发的疗效上无明显差异（P〉0．05），在不孕的疗效上诺雷德妊娠率较高（P〈0．05）；内关通组常见的副反应有肝功能损害、阴道出血、痤疮、体重增加等，而诺雷德组常见副反应主要为绝经期症状。【结论】腹腔镜手术联合药物内美通或诺雷德治疗子宫内膜异住症相关性慢性盆腔痛均能显著提高症状缓解率、妊娠率及降低复发率。两种药物均有一定的不良反应，在临床治疗过程中应个体化用药。

Observation of the Efficacy of Laparoscopic Surgery Combined with Drug Therapy for the Treatment of Endometriosis

[Objective]To explore the clinical efficacy of laparoscopy combined with drug therapy for the treatment of endometriosis. [Methods] A total of 128 patients with endometriosis undergoing laparoscopy and confirmed by pathology from April 2008 to Aug. 2011 were analyzed retrospectively. The efficacy, pregnancy rate, the recurrence rate after operation and the incidence of drug adverse reaction of simple laparoscopy vs laparoscopy combined with nemestran or zoladex for the treatment of endometriosis-related chronic pelvic pain were compared. [Results] All patients with chronic pelvic pain were diagnosed as endometriosis by pathology after operation. After all patients underwent laparoscopy, the symptoms such as chronic pelvic pain, dysmenorrheal, menstrual disorder, infertility and ovarian cysts were improved. Compared with control group, the remission rate and pregnancy outcome increased and the relapse rate decreased obviously in nemestran group and zoladex group（ P〈0. 05）. There was no significant difference in the pain remission rate and relapse rate between nemestran group and zoladex group（ P〉0.05）, while the pregnancy rate in zoladex group was higher （ P 〈0.05）. The common side effects in nemestran group were liver damage, vaginal bleeding, ache and weight gain, etc. And the common side effects in zoladex group were menopausal symptoms. [Conclusion]Both simple surgery and drug therapy have rationality and limitation. Laparoscopy combined with nemestran or zola- dex for the treatment of endometriosis-related chronic pelvic pain can markedly increase the remission rate, pregnancy rate and decrease the relapse rate. Both two drugs have certain adverse reactions. During the course of clinical treatment, the personalized medicine should be taken.